PA seeing patient in hospital billing fx care

[Jennifer17]

medicare is denying a patient that our PA saw and had a fx so we billed a global fx care and now medicare says he is ineligible to paid for this procedure
what to do now?

 

[mitchellde]

Is you PA credentialed with Medicare? Does your state limit the scope of practice for PAs? If your PA us credentialed and this service is out of the scope of practice for a PA in your state then there is nothing you can do. You cannot refill the claim nor can you bill the patient. If the PA is not credentialed with Medicare then there is still nothing that can be done. You cannot bill under another provider and you cannot bill the patient. The only way to fight this is if your PA is credentialed and the state does not limit the scope of practice.

 

[Jennifer17]

yes he is credentialed with Medicare, I am in CT -I was not aware certain procedures he cannot do - many times our docs will send the PA to the hospital when we are on call and they dictate the report and the report on the top will say "attending doctor " with our doctors name but then on the bottom where they sign off it says "PA's name dictated for Doctors name"- I will have to make sure the docs see these patients and not the PA's- do you know where I can reference where it would say what the PA's cannot do in our state?

Thanks in advance

 

[mhstrauss]

yes he is credentialed with Medicare, I am in CT -I was not aware certain procedures he cannot do - many times our docs will send the PA to the hospital when we are on call and they dictate the report and the report on the top will say "attending doctor " with our doctors name but then on the bottom where they sign off it says "PA's name dictated for Doctors name"- I will have to make sure the docs see these patients and not the PA's- do you know where I can reference where it would say what the PA's cannot do in our state?

Thanks in advance

In Louisiana, the State Board of Medical Examiners governs PA scope of practice. Not sure about all states, but that may be a good starting point for you, for researching which procedures your PA's can do.

As for consults...whoever saw the patient is who should be billing for the charge. If the PA is the only provider that saw the patient on that particular DOS, the physician cannot bill for it. If both the MD and PA see the patient the same DOS, Medicare does have a Split/Shared Visit rule, but it only applies to certain types of visits...and consults is not one of them. More info on that here:

https://www.aapc.com/blog/23741-medicares-splitshared-visit-policy/